Phone-Based Postpartum Continuing Care: Smoking Cessation Beginning in Pregnancy

基于电话的产后持续护理：从怀孕开始戒烟

• 批准号: 8884766
• 负责人: Victoria Hope Coleman-Cowger
• 金额: $ 22.34万
• 依托单位: BATTELLE CENTERS/PUB HLTH RES & EVALUATN
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8884766
• 关键词: Abstinence; Address; Advisory Committees; African American; American College of Obstetricians and Gynecologists; Appointment; Asthma; Baltimore; Behavioral; Birth; Breast Feeding; Bronchitis; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Child; Childbirth; Chronic; Cigarette; Clinic; Clinical Trials; Control Groups; Cotinine; Counseling; Education; Educational process of instructing; Effectiveness; Environmental Tobacco Smoke; Exposure to; Family member; First Pregnancy Trimester; Focus Groups; Goals; Health; Health Professional; High Prevalence; Hotlines; Human Milk; Infant; Intervention; Life; Literature; Low income; Maryland; Minority; Modeling; Monitor; Mothers; Motivation; Nicotine; Outcome; Passive Smoking; Physicians; Pilot Projects; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Preventive; Preventive Intervention; Procedures; Protocols documentation; Public Health; Randomized; Recovery; Recruitment Activity; Relapse; Relative (related person); Reporting; Risk; Sampling; Schedule; Second Pregnancy Trimester; Services; Smoke; Smoking; Stress; Sudden infant death syndrome; Telephone; Testing; Third Pregnancy Trimester; Time; Tobacco use; United States; United States Dept. of Health and Human Services; United States Substance Abuse and Mental Health Services Administration; Visit; Woman; Work; aged; base; checkup examination; disorder later incidence prevention; effective intervention; evidence base; flexibility; follow-up; improved; infant monitoring; premature; prenatal; prevent; quitline; respiratory; skills; smoking cessation; standard care; standard of care; transmission process; unborn child; urban area; willingness

DESCRIPTION (provided by applicant): The large majority of women who quit smoking during pregnancy relapse in the first six months postpartum, highlighting a need for effective postpartum continuing care that supports women through the challenging postpartum period when stress is high and motivation to stay quit may decline. Existing relapse prevention interventions (typically delivered during pregnancy) have been found to be of little benefit during the postpartum period, suggesting the need for a more formal continuing care approach. Phone-based protocols for smoking cessation have been widely disseminated and effective because they address the need for flexible access, but are passive and not typically utilized by women in the postpartum period. The proposed pilot study will develop and test a Phone-based Postpartum Continuing Care (PPCC) model that draws from existing evidence-based protocols--the 5 A's and Recovery Management Checkups (RMC)-- shown to be effective with other populations. The experimental PPCC will reinforce the importance of abstinence, relapse prevention, and reduced smoking through proactive re-intervention (i.e., RMC) with the 5 A's at times when postpartum women are more likely to relapse, and provide education and monitoring of the infant's direct and indirect exposure to nicotine through breastfeeding and secondhand smoke. We will evaluate PPCC's effectiveness relative to a passive referral to a 24/7 hotline, which is current standard care.., Approximately one hundred thirty women in their first or second trimester of pregnancy who were nicotine-dependent in the past year, currently smoke, or quit within the past 90 days will be recruited at their first prenatal appointment at the Maryland Women's Center (MWC) in Baltimore, Maryland. All women will receive the clinic's standard of care for smoking cessation--the 5 A's --during pregnancy from their physician. Half will be randomly assigned to an experimental group getting PPCC for 6 months postpartum and half to a control group receiving only a referral to a passive 24/7 state quit line postpartum. It s expected that in the 6 months following childbirth women in the experimental PPCC (relative to those in the control group) will: a) smoke fewer cigarettes, b) smoke fewer days, c) go longer before postpartum relapse, d) have less time between relapse and talking to a health professional about smoking, e) have less time between relapse and resumption of abstinence , f) smoke fewer times while breastfeeding, g) smoke fewer times while in the same room as the infant, and h) reduce their infant's cotinine levels. The aims of this pilot project are to develo PPCC from existing evidence-based approaches, demonstrate the feasibility of implementing the PPCC intervention with at least 80% compliance and at least 80% follow-up at each wave, and evaluate the effect size associated with receiving standard care vs. standard care + PPCC in order to understand the promise of and appropriate power required for a larger clinical trial.

说明(申请人提供)：大多数在怀孕期间戒烟的妇女在产后前六个月复发，这突显了有效的产后持续护理的必要性，以支持妇女度过具有挑战性的产后时期，此时压力很大，戒烟的动力可能会下降。现有的复发预防干预措施(通常在怀孕期间提供)在以下几年中被发现几乎没有好处 产后期，表明有必要采取更正式的持续护理方法。以电话为基础的戒烟方案得到了广泛传播和有效，因为它们满足了灵活获得的需要，但是被动的，通常不被妇女在产后期间使用。这项拟议的试点研究将开发和测试一个基于电话的产后持续护理(PPCC)模型，该模型借鉴了现有的循证方案--5A和康复管理检查(RMC)--被证明对其他人群有效。试验性的PPCC将在产后妇女更有可能复发的时候，通过积极的再干预(即RMC)加强戒烟、预防复发和减少吸烟的重要性，并提供教育和监测婴儿通过母乳喂养和二手烟直接和间接接触尼古丁的情况。我们将评估PPCC相对于被动转介到24/7热线的有效性，这是目前的标准护理。大约130名怀孕第一或第二个月的妇女在过去一年中尼古丁依赖，目前吸烟，或在过去90天内戒烟，将在她们的第一次产前预约时在 马里兰州巴尔的摩的马里兰州妇女中心(MWC)。所有女性在怀孕期间都将接受诊所的戒烟标准--5A标准--由她们的医生提供。一半将被随机分配到产后6个月接受PPCC治疗的试验组，另一半被分配给对照组，后者只接受产后24/7被动戒烟路线的转诊。S预计，在分娩后的6个月里，PPCC实验组的妇女(相对于对照组)将：a)减少吸烟，b)减少吸烟天数，c)产后复发前的时间更长，d)复发和咨询健康专家讨论吸烟的时间更短，e)复发和恢复戒烟之间的时间更短，f)哺乳时吸烟的次数更少，g)与婴儿同住一室时吸烟的次数更少，h)降低婴儿的可替宁水平。这个试点项目的目的是从现有的循证方法发展PPCC，证明实施PPCC干预的可行性，在每波至少80%的遵从性和至少80%的随访率下，并评估与接受标准护理和标准护理+PPCC相关的效果大小，以便了解更大规模临床试验所需的承诺和适当的权力。